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Issue 1,575: June 30, 2021
Top Stories

IAC Handouts

Featured Resources

Conferences and Meetings

Immunization PSAs from the Archive


Top Stories

IAC summarizes the June 23–25 ACIP meeting: myocarditis after mRNA COVID-19 vaccination, dengue vaccine for children in endemic areas, influenza vaccines for the 2021–22 season, rabies vaccine recommendation updates for children, and more

The Advisory Committee on Immunization Practices (ACIP) conducted its virtual meeting on June 23–25, 2021. Slides presented are available online. ACIP considered six preventable diseases: COVID-19, dengue, influenza, rabies, zoster, and pneumococcal disease. 

COVID-19: Myocarditis – Cases of myocarditis (inflammation of heart muscle) and pericarditis (inflammation of membrane surrounding the heart) have been reported following mRNA COVID-19 vaccination. These reports triggered rapid, in-depth safety investigations by CDC and FDA. Available data and the assessment by the COVID-19 vaccine safety subcommittee were presented to the ACIP. Among people given mRNA COVID-19 vaccine, myocarditis was rare, but occurred significantly more often than would be expected in unvaccinated younger people, especially males younger than age 30 and especially after dose 2. Among cases, symptom onset typically began within 1 week of vaccination and hospitalization was common. Available information showed that patient outcomes were good, and no deaths were reported. CDC compared the risks of myocarditis after vaccination against the risks of COVID-19 illness among unvaccinated teens and young adults. Even among teenaged males with the highest rates of myocarditis after vaccination, the balance of risks and benefits clearly favored vaccination. ACIP members agreed that benefits of mRNA COVID-19 vaccination continue to outweigh risks of vaccination and made no changes to current recommendations. ACIP will continue to monitor the situation. FDA updated the EUA Fact Sheets for mRNA COVID-19 vaccines to explain the rare risk of myocarditis and what to do if symptoms develop. CDC’s updated clinical considerations on myocarditis offer practical guidance for patients with a history of myocarditis or pericarditis and for those who develop symptoms after vaccination. CDC, HHS, and professional societies continue to recommend COVID-19 vaccination for all people 12 years of age and older.

Action steps: Update EUA Fact Sheets used in your clinic to current versions. Familiarize staff (including emergency room personnel) with revised clinical considerations. All adverse events following immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS).

COVID-19: Other safety issues – Reports to v-safe and VAERS for 12- to 15-year-old recipients of Pfizer-BioNTech COVID-19 Vaccine did not identify unexpected safety concerns (other than myocarditis, as discussed above) nor issues with daily activities. 

COVID-19: Booster doses – ACIP discussed data that will be needed for the committee to consider when or if it should make recommendations for booster doses in certain populations. CDC is monitoring the antibody levels and breakthrough infections in vaccinated groups, including immunocompromised people. Antibody levels appear to decline over time and an additional dose appears to boost antibody levels. ACIP will consider booster doses for some or all groups if evidence emerges of more breakthrough cases due to waning immunity or if a new variant emerges that evades the vaccines’ protection. 

Dengue vaccine vote – ACIP considered the Evidence to Recommendations (EtR) framework applied to the dengue tetravalent vaccine live, Dengvaxia (Sanofi Pasteur). Dengue infection is most dangerous the second time a person is infected with the virus. Vaccination of naïve individuals may lead to a more severe subsequent dengue illness in some people. Therefore, testing is recommended before vaccination to minimize the risk of vaccinating someone who has never had dengue. Dengue incidence is endemic in the territories of Puerto Rico, U.S. Virgin Islands, and American Samoa. A critical consideration in the ACIP’s decision was the perspectives of clinicians and parents regarding this complex testing and vaccination program. Data were presented showing that most Puerto Rico physicians and parents surveyed believed that implementing the program would be feasible and desirable to protect children at risk of severe dengue disease. ACIP voted unanimously to recommend a 3-dose series of Dengvaxia (0, 6 months, 12 months) for children age 9 through 16 years who have had laboratory confirmation of previous dengue infection and who reside in endemic areas. ACIP also voted to add Dengvaxia to the Vaccines For Children (VFC) program for Puerto Rico, the U.S. Virgin Islands, and American Samoa, noting the eligible areas could be updated if dengue-endemic areas of the U.S. or its territories change.

Influenza vaccine vote – ACIP unanimously affirmed its unchanged recommendations for influenza vaccines for 2021–22: Annual influenza vaccination is recommended for all persons age 6 months and older who do not have contraindications. The presentation slides include a summary graphic of vaccines for the 2021–22 season organized by age indication. For the first time, all 2021–22 vaccine formulations will be quadrivalent. The A/H1N1 and A/H3N2 components of the 2021–22 influenza vaccines are new, whereas the B/Yamagata and B/Victoria components are unchanged from last season’s formulation. Flucelvax Quadrivalent (Seqirus) is now approved and recommended for people age 2 years and older. ACIP noted that influenza and COVID-19 vaccines may be given at the same visit if necessary: CDC has published additional guidance on coadministration of COVID-19 vaccines and other vaccines. ACIP recommends that the earliest available doses of influenza vaccine be given to two groups: pregnant people during the third trimester (to protect the recipient and the newborn in the first months of life), as well as children who need two doses for protection. For non-pregnant adults, vaccination by the end of October is ideal, while influenza vaccination during July and August should be avoided unless there is concern that later vaccination might not be possible. 

Rabies vaccine vote – ACIP unanimously voted to extend its current pre-exposure prophylaxis (PrEP) recommendations for adults to also include children younger than age 18 years (e.g., children living in rabies-endemic countries for prolonged periods). The need for PrEP is based on a person’s activities, the frequency and location of their encounters with specific types of animals, and their access to medical care if exposed. PrEP is now recommended to be given as an intramuscular (IM), 2-dose series (0, 7 days) in immunocompetent children. Children who are expected to have a sustained, elevated risk for rabies exposures for 3 or more years after the primary series may either have a titer check 1 to 3 years after vaccination (and an IM booster dose if needed) or simply have a booster dose of rabies vaccine 21 days to 3 years after initiating the series.

Zoster – ACIP is considering recommendations for the use of recombinant zoster vaccine (RZV, Shingrix, GSK) in immunocompromised individuals age 19 years and older. It reviewed the elevated burden of herpes zoster in adults with various forms of immunocompromise, as well as a description of studies to evaluate the safety and effectiveness of Shingrix in several immunocompromised populations. Additional presentations are planned for future meetings. 

Pneumococcal vaccine in adults – ACIP discussed U.S. disease epidemiology and differences in cost-effectiveness model results for the 20-valent pneumococcal conjugate vaccine recently licensed by FDA (PCV20, Pfizer) and the 15-valent pneumococcal conjugate vaccine anticipated to be licensed by FDA later this summer (PCV15, Merck), as well as several possible vaccination strategies for adults. CDC anticipates additional discussion at a future ACIP meeting before October, with a vote on recommendations in October 2021. 

Future meetings – Currently, the next scheduled ACIP meeting will be held October 20–21, 2021, although CDC will soon announce an additional meeting, possibly in September 2021. Other emergency meetings may be held as needed related to COVID-19 vaccines. Information about past and future ACIP meetings may be found on the ACIP website. Opportunities for public comment are described on the web page. 

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Spread the word! IAC offers FREE “I Got My COVID-19 Vaccine” buttons and stickers to those promoting vaccination in hesitant communities! Available in English and Spanish.

Public health departments, nonprofit organizations, and clinics that provide vaccination services in communities experiencing health disparities or vaccine hesitancy can order IAC’s FREE “I Got My COVID-19 Vaccine” buttons and stickers, provided with support from CDC. Available in English and Spanish, the buttons and stickers can be placed on lab coats, uniforms, jackets, lanyards, ID badges, or backpacks to show confidence in COVID-19 vaccination. Access this order form to request the FREE buttons and stickers for your outreach efforts.

Buttons and stickers remain available for sale to those not eligible for the CDC-funded supplies. 

HHS’s We Can Do This campaign, supported by the Made to Save Coalition, encourages us to redouble efforts to protect at least 70% of adults by Independence Day. During this National Month of Action, initiatives include making it easier to get vaccinated against COVID-19, advancing equity, doing more vaccine education, and encouraging vaccination of everyone in your community.


According to the CDC COVID Data Tracker, as of June 29, 171,083,955 U.S. adults at least 18 years of age (66.2%) have received at least one COVID-19 vaccination.

Declare independence from COVID-19! Commit to the National Vaccine Month of Action: go to the web page to locate events near you or add your own.

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Happy Canada Day! A summary of immunization information and advocacy in Canada 

O Canada! In tribute to Canada’s 154th national anniversary, July 1, we are sharing select Canadian resources for immunization information and advocacy. Best wishes to all our vaccinating friends in Canada!

Expert committees:

Advocacy groups and resources:

Helpful resources:

COVID-19 resources:

Government institutions: 

These Canadian documents and resources are provided in French by clicking “Français” at the top right of the web pages.

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MMWR Recap: COVID-19 Vaccination Coverage among Adults and COVID-19 Vaccination Coverage and Intent among Adults Age 18–39 Years

CDC recently published: 

  • COVID-19 Vaccination Coverage and Intent among Adults Aged 18–39 Years—United States, March–May 2021 (MMWR, June 25, HTML format or PDF format)
  • COVID-19 Vaccination Coverage among Adults—United States, December 14, 2020–May 22, 2021 (MMWR, June 25, HTML format or PDF format)

Related Link

  • MMWR gateway page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplement

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IAC Spotlight! Check out the many adolescent vaccination resources on during back-to-school preparation

Explore IAC's adolescent vaccination resources on IAC offers many educational materials to inform parents and aid healthcare professionals in discussions with parents and patients, including:

IAC's Handouts: Adolescent Vaccinations gateway page offers parent and patient resources including: 

IAC's Clinic Tools: Adolescent Vaccination gateway page offers educational pieces for healthcare professionals and their patients from IAC, CDC, AAFP, AAP, Vaccine Education Center, and others.

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In all, 537 institutions have achieved a place on IAC’s Hepatitis B Birth Dose Honor Roll, including two new honorees. Three previously honored institutions qualify for additional years' honors.
The Immunization Action Coalition (IAC) is pleased to announce that two new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 537 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Doylestown Health, Doylestown, PA (90%)
  • Oak Hill Hospital, Brooksville, FL (97%)

One institution is being recognized for a third year:

  • WellSpan Good Samaritan Hospital, Lebanon, PA (91%)

One institution is being recognized for a fourth year:

  • Warren General Hospital, Warren, PA (90%)

Finally, one institution is being recognized for a fifth year:

  • AHN Jefferson Hospital, Jefferson Hills, PA (91%)

The Honor Roll now includes 537 birthing institutions from 44 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred twenty institutions have qualified twice, 73 institutions have qualified three times, 42 institutions have qualified four times, 24 institutions have qualified five times, 22 institutions have qualified six times, eight institutions have qualified seven times, two institutions have qualified eight times and one institution has qualified nine times.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give Birth to the End of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90% or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s more than 52,000 readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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IAC experts called on by news media

Journalists seek out IAC experts to help explain vaccines to the public and policy makers. Our goal is to help the media understand and communicate the complex work vaccinators do. Here are recent citations:

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Not-to-miss immunization articles in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination:

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IAC Handouts

IAC updates its handout for healthcare professionals titled “Don't Be Guilty of These Preventable Errors in Vaccine Administration!”

IAC recently posted its updated resource for healthcare professionals titled Don't Be Guilty of These Preventable Errors in Vaccine Administration!  Changes include the addition of a CDC resource on avoiding or responding to COVID-19 vaccine errors, including updating several existing links.

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Featured Resources

Organizing a new vaccination program? Use IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide—free to download by chapter or in its entirety 

Download IAC's free book on all aspects of adult immunization to help train your team and refresh your leaders: Vaccinating Adults: A Step-by- Step Guide (Guide).


This up-to-date, thorough "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting.

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

The Guide is available to download/print either by chapter or in its entirety free at The downloaded version is suitable for double-sided printing. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.

The Guide is a uniquely valuable resource to assist providers in increasing adult vaccination rates. Be sure to get a copy today!

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Encourage friends to get vaccinated by adding IAC’s “I Got My COVID-19 Vaccine” Facebook profile photo frame! Available in English and Spanish.

Share your excitement about COVID-19 vaccination and inspire your friends! When you have received your COVID-19 vaccine, add IAC's new "I Got My COVID-19 Vaccine" Facebook photo frame to liven up your profile picture!

You can obtain the frame in three ways:

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Going fast! Order IAC's laminated version of CDC's 2021 U.S. child/adolescent immunization schedule today! Adult schedules sold out.

IAC's laminated version of the 2021 U.S. child/adolescent immunization schedule is available for order. The laminated 2021 U.S. adult immunization schedule has sold out, but you can print paper versions from the CDC website.

These schedules are ideal for use in any busy healthcare setting where vaccinations are given. Their tough coating can be wiped down, and they’re durable enough to stand up to a year's worth of use. 
The child/adolescent schedule is eight pages (i.e., four double-sided pages), but folds down to a convenient 8.5" x 11" size.


With color coding for easy reading, our laminated schedules replicate the original CDC formatting, including the essential tables and notes.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders of 1,000 copies or more, call 651-647-9009 or email

Visit the Shop IAC: Laminated Schedules web page for more information on the schedules, to view images of all the pages, and to download the order form today!

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Conferences and Meetings

AAP 2021 National Conference and Exhibition scheduled on October 8–12 in Philadelphia and online; registration open

The American Academy of Pediatrics (AAP) will host its 2021 National Conference and Exhibition as a hybrid event on October 8–12 in Philadelphia. Attendees will have the option of participating in the full conference (live, in-person sessions and activities plus all on-demand content and virtual sessions) or the virtual-only experience.

Visit the meeting web page for information about conference and hotel registration, presentations, and more. The deadline for submitting content is July 9.

Register to attend.

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Immunization PSAs from the Archive

In this 1996 PSA from the Scottish Rite Children's Medical Center in Georgia, a young "John Smoltz" throws vaccine-preventable diseases out of the park

In this 1996 public service announcement (PSA) from the Scottish Rite Children’s Medical Center in Georgia, a pitching toddler and narrator John Smoltz remind us to give children a bright future by getting them fully vaccinated. This PSA is part of a collection curated by vaccine expert William L. Atkinson, MD, MPH, which spans a period of more than 50 years.

Previous PSAs featured in “From the Archives” are available when viewing this Vimeo video

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.

IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC.

IAC Express Disclaimer
ISSN: 1526-1786

Our mailing address:
Immunization Action Coalition
2550 University Avenue West, Suite 415 North
Saint Paul, MN 55114

About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

IZ Express Disclaimer
ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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